Migrants' perceptions of aging in Denmark and attitudes towards remigration: findings from a qualitative study

A Scoping Review on Community-Based Programs to Promote Physical Activity in Older Immigrants

Older immigrants are at higher risks for inactivity due to cultural, environmental, and social barriers in the postmigration context. Community-based physical activity (PA) programs increase PA in older adults, yet little is known about approaches that specifically target older immigrants. This scoping review explores the literature on community-based programs that increase PA and physical fitness in immigrant older adults and identifies barriers and facilitators to PA program participation in this population. A systematic search of electronic databases and gray literature was conducted, and a total of 11 articles met the inclusion criteria after full-text screening. A range of populations and PA program characteristics are described, yet there is a lack of studies on older immigrant men, Black older immigrants, and immigrants from Arab and African countries. There is a need for further research to develop evidence-informed PA programs for this diverse population.

Development of a complex intervention (safe and secure) to support non-western migrant patients with palliative care needs and their families

PURPOSE

International evidence supports the benefits of early use of palliative care, although the best use of services is often under-utilised among Danish migrants. The study aims to develop a theoretically informed, evidence-based intervention to increase support in palliative care service provision among non-western migrant patients with a life-threatening disease and their families in Denmark.

METHODS

The overall approach was guided by the United Kingdom Medical Research Council framework for developing and evaluating complex interventions by involving stakeholders for example patients, family caregivers, and healthcare professionals. The intervention was developed iteratively by incorporating theory and evidence. Evidence was synthesized from a systematic review, semi-structured interviews, and group discussions with patients (n = 8), family caregivers (n = 11), healthcare professionals (n = 10); and three workshops with migrants (n = 5), social and healthcare professionals (n = 6). The study took place in six different settings in two regions across Denmark.

RESULTS

The safe and secure complex intervention is a healthcare professional (e.g. nurse, physiotherapist, or occupational therapist) led patient-centred palliative care intervention at the basic level. The final intervention consists of three components 1. Education and training sessions, 2. Consultations with the healthcare professional, and 3. Coordination of care.

CONCLUSION

This study describes the development of a supportive palliative care intervention for non-western migrant patients with palliative care needs and their families, followed by a transparent and systematic reporting process. A palliative care intervention combining multiple components targeting different stakeholders, is expected that safe and secure is more suitable and well customized in increasing access and use of palliative care services for non-western migrant families in Denmark.

Improving the sense of city belonging among migrant elderly following family from an elderly service perspective: a cross-sectional study

Background

The migrant elderly following family (MEFF), who migrates to new community to reunite with families, may face challenges of city integration and belonging. This study aims to explore from an elderly service perspective how to improve the sense of city belonging for MEFFs with and without hypertension/diabetes conditions.

Methods

Data were derived from the 2017 China Migrants Dynamic Survey and China National Statistical Yearbooks in 2017. The study included 882 MEFFs with hypertension or diabetes and 1266 MEFFs without hypertension and diabetes. Hierarchical linear modeling was applied to analyze the effects of individual and provincial elderly services on sense of city belonging among the MEFF with and without hypertension/diabetes.

Results

The MEFFs with hypertension or diabetes exhibited a greater sense of city belonging when they were familiar with a wider range of health education topics (γ = 0.05, p = 0.033) and were in those provinces with a greater number of licensed doctors (γ = 0.39, p < 0.001) and hospitals (p = 0.042). For those MEFFs without hypertension or diabetes, social security cards (γ = 0.57, p < 0.001) and awareness of a wider range of health education topics (γ = 0.07, p = 0.018) may help to improve their sense of city belonging.

Conclusion

This study calls for strengthening the accessibility in inclusive elderly services, and minimizing or even eliminating the inequality in elderly services at the individual and provincial levels to increase sense of city belonging among the MEFFs. For the MEFFs with hypertension or diabetes, health managers should focus on improving health information dissemination and increasing the number of doctors per 1000 people as well as and the number of hospitals to enhance the sense of city belonging. Moreover, the government should strengthen social security and health education to facilitate the adaptation and integration of MEFFs without hypertension and diabetes into the host city.

Examining Social Relationships among Older Muslim Immigrants Living in Canada: A Narrative Inquiry

Social connectedness and engagement are particularly important among groups who are at risk of experiencing social isolation, such as immigrant older adults. The objective of our study was to understand the social relationships of aging Muslim Lebanese immigrants living in Canada by exploring their lives in their ethnic and wider communities. This study used a life course perspective and adopted a constructivist narrative inquiry to understand the diverse lived experiences of four older adults who immigrated to Canada during early adulthood. Participants engaged in a narrative interview and follow-up session in which they storied their lived experiences. Findings describe one core theme, cultivating social relationships through family, friends, and community interdependence, and three related sub-themes: (1) navigating and creating family interdependence and planting new roots; (2) family interdependence in later life: the important role of grandchildren; and (3) cultivating ethnic and local interdependence to support aging in place. The participants’ stories provided an understanding of how culture, religion, aging, family, and immigration experiences interrelated throughout their life course and shaped their social relationships during later life. This study sheds new insight on the importance of culturally tailored activities and awareness about the social needs of immigrant older adults.

Intended place of residence in old age of internal migrants aged 15-64 years: a citywide cross-sectional study in Shanghai, China

OBJECTIVES

To explore the intentions of working-age internal migrants concerning their place of residence in old age and the relevant influencing factors.

METHOD

A cross-sectional survey was conducted in the 17 districts of Shanghai, China in 2013. Through multi-stage stratified sampling with probability proportional to size, 7968 internal migrants (aged 15-64 years) were selected and interviewed individually face to face. The primary outcome concerned the intended place of residence in old age of internal migrants living in Shanghai. Information was collected on demographic characteristics, health insurance, economic condition and participation in social activities. Multinomial logistic regression was performed to analyse the factors influencing migrants' intentions concerning their place of residence in old age.

RESULTS

A total of 7927 working-age migrants with complete data were analysed. Of these, 57.0% intended to live in their hometown in old age, 17.7% planned to remain in Shanghai and 25.3% were undecided. Those respondents who were male, less educated, from rural areas or Western China, living in rental houses or who had left family members behind in their hometowns were more likely to choose their hometown as their intended residence in old age (p<0.05). Engagement in business, longer residence duration, possession of social insurance and participation in social activities in Shanghai were identified as possible motivators for migrants who intended to remain in Shanghai in old age (p<0.05).

CONCLUSIONS

Most of the migrants expressed an intention to remigrate to their hometowns in old age. Education, economic capacity and social insurance influenced internal migrants in their decision. Relevant authorities should monitor the remigration pattern of ageing migrants, strengthen the senior care system and prepare health service resources that are more adequate, especially in the provinces or cities whence the migrants came.

Ethnic inequality within the elderly population in utilizing healthcare services

The accessibility of minority ethnic groups to healthcare services is challenging in many societies, most especially among the elderly population. Elderly individuals from minority groups have been found to have lower levels of utilizing healthcare services, including preventive care, intensive hospital care, advanced technological procedures and rehabilitation. Universal health coverage is incapable of addressing all of healthcare's access inequities and there is a need to assess the overall outcomes, including mortality rates over time, functionality of discharged patients, quality of life and/or unplanned readmissions that may indicate low quality hospital discharge processes. There is a need to investigate the impact of perceived trust/distrust in the healthcare system of elderly patients from minority ethnicities on their willingness to consume medical services.To ensure equity in service provision, there is a need to examine whether medical providers, even unconsciously, prioritize vital services, such as rehabilitation services to populations that share similar social backgrounds. An essential measure is enhancement of health literacy at all levels, from the individual to policy-makers and strategic adoption of health literacy programs that encompass all ethnicities, considering their respective needs, norms and expectations.Ethnic equality in accessing medical services is crucial in view of the numerous migrants and asylum-seekers who look for refuge in varied societies globally. Such populations are perceived as faring worse in healthcare quality of care, and this highlights the need to adapt the healthcare systems to the varied health behaviors, contextual factors, language barriers, lower health literacy levels and limited access to timely care. Improving equity and access to medical care is dependent on enhanced health literacy; policies that consider diverse needs of majority and minority groups; and advanced research. Concurrent implementation of these measures will be well aligned with the global strive to promote the Sustainable Development Goals (SDGs).

Community-based interventions to enhance healthy aging in disadvantaged areas: perceptions of older adults and health care professionals

Background

The number of older adults with different ethnic and socioeconomic background is steadily increasing. There is a need for community-based health promotion interventions for older adults that are responsive to ethnic and socioeconomic diversity among target populations. The aim of this study is to explore encounters between older adults living in disadvantaged areas and health care professionals in the context of community-based health promotion.

Methods

Qualitative methods were used involving interviews and focus groups with older adults (n = 22) and municipal health care professionals (n = 8), and multiple observations were conducted. Data were analyzed thematically.

Results

Findings show a gap between health promotion services and older adults due to a perception of services as being neither accessible nor acceptable in the context of complex health and psychosocial needs. Health care professionals reported trust, proximity and presence as fundamental factors for improving acceptability and accessibility of health promotion services.

Conclusions

There is a need to develop participatory approaches to engage older adults who live in disadvantaged areas in municipal health promotion services and to ensure that these services are relevant to these groups.

Role of disease and demographic factors as determinants of return migration: A nationwide register-based cohort study

AIMS

A number of aspects of the health status of migrants who return to their country of origin have been explored in the literature; however, a more general description of the incidence of disease and demographic characteristics is lacking. The aim of this research was to contribute such a description.

METHODS

A nationwide cohort study was conducted of 114,331 migrants who obtained residence in Denmark between 1 January 1993 and 31 December 2010. Demographic characteristics and ten disease groups were included as explanatory variables and hazards ratios for the association between return migration and disease incidence, as well as demographic characteristics, were estimated using Cox regressions.

RESULTS

The tendency to return-migrate when ill was not the same among younger and elderly migrants; migrants <55 years of age had a significantly smaller propensity to return-migrate if they had suffered from a disease during the 18 years of follow-up compared with those who had not had a disease, whereas migrants ≥55 years of age were more prone to return if ill. The likelihood of returning decreased with increasing comorbidity in both age groups. Among those who were <55 years of age, the tendency to return increased with age at obtainment of residence; among those who were ≥55 years, more men than women return-migrated.

CONCLUSIONS

In Denmark, younger migrants are less inclined to return-migrate if they are ill compared with healthy migrants, whereas elderly migrants are more inclined to return if ill. The returnees also differ demographically from non-returnees in various ways.

Teaching gerontology in globalized academics: a qualitative study of Thai nursing students' views on ageing when studying abroad

BACKGROUND

Negative views towards ageing and older adults may be a reason why nurses do not choose to work in gerontological nursing. Studying in another cultural context can challenge these views. The Objective was to explore nursing students' views on ageing and older adults before and after a gerontology course held abroad.

DESIGN AND METHOD

A qualitative approach based on content analysis of responses to open-ended questions by 30 Thai nursing students studying a gerontology course in Sweden.

RESULTS

Three main categories: positive imprints of ageing, ageing takes its toll, and knowledge leading to action, emerged through sub-categories carrying a view of older adults as not only in need of care, but also as resourceful and competent. Professional healthcare, besides family was seen as potential caregivers in old age.

CONCLUSIONS

Studying gerontology abroad can widen views towards ageing and older adults, inspiring nurses to work in gerontological nursing.

Aging and health among migrants in a European perspective

Population aging and the associated changes in demographic structures and healthcare needs is a key challenge across Europe. Healthy aging strategies focus on ensuring the ability to maintain health, quality of life and independent living at old age. Concurrent to the process of population aging, the demographics of Europe are affected by increased migration resulting in substantial ethnic diversity. In this paper, we narratively review the health profile of the growing proportion of aging migrants in Europe, outline key factors shaping health among this diverse group and consider ways of addressing their healthcare needs.

Although factors shaping aging processes are largely similar across populations, migrant-specific risk factors exist. These include exposure to health risks before and during migration; a more disadvantaged socioeconomic position; language barriers and low health literacy; cultural factors influencing health-seeking behaviours; and psychosocial vulnerability and discrimination affecting health and quality of life. Overall, migrants experience the same morbidity and mortality causes as the native populations, but with different relative importance, severity and age of onset and with substantial differences within and between migrant groups. Little is known regarding health behaviours among aging migrants, although differences in cancer screening behaviours have been identified. Indications of widening health differentials between migrants and native populations with age and informal barriers to quality healthcare for aging migrants are causes of concern.

In conclusion, there is a need for attention to migration alongside other determinants of healthy aging. The diversity in individual characteristics, life course processes and contextual factors shaping aging processes among migrants point to the need for a sensitive and comprehensive approach to policies, practices and research within the field of healthy aging. This is important to accommodate for the needs of the growing number of aging migrants in Europe and counter inequities in health and well-being at old age.

Return Migration among Elderly, Chronically Ill Bosnian Refugees: Does Health Matter?

Elderly migrants constitute a considerable share of global return migration; nevertheless, literature on the health aspects of the return migration among these migrants is still scarce. This study explores the significance of return migration among elderly, chronically ill Bosnian refugees from Denmark and the role of health issues in their decision to return. It is based on semi-structured interviews with 33 elderly, chronically ill Bosnian refugees who have moved back to Bosnia and Herzegovina, and 10 elderly, chronically ill Bosnian refugees who have remained in Denmark. The interviews show that physical health, in the sense of the absence of illness and easy access to necessary health-care services and medicines, was not highly prioritized when the decision was made whether or not to return. However, if health is regarded more broadly as involving more than mere physical health and the absence of illness, health did matter. Viewed as physical, social and mental well-being in line with WHO’s definition of health, health was indeed one of the most important factors when the decision to return was made.